Provider Demographics
NPI:1275604381
Name:DUAN, MARY Y (DIPL AC (NCCAOM))
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:Y
Last Name:DUAN
Suffix:
Gender:F
Credentials:DIPL AC (NCCAOM)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 MAPLE GROVE LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6692
Mailing Address - Country:US
Mailing Address - Phone:301-947-7688
Mailing Address - Fax:
Practice Address - Street 1:1221 MAPLE GROVE LN
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6692
Practice Address - Country:US
Practice Address - Phone:301-947-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01409246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other